Understanding Your Benefits
We strive to inform patients of anticipated insurance coverage of services, however specific benefits depend on type of plan.
In general, Medicare B covers 80% of Chronic Disease and Metabolic services and secondary Medicare insurance plans (usually Plan Gs or Senior Supplements) cover the remaining 20% and have an annual deductible. Medicare patients may be required to sign an ABN for a specific service, lab draws or optional services such as Medical Nutrition Therapy or Obesity Behavioral Therapy, as Medicare may deem some of these services not medically necessary. We collect co-pays for Medicare Advantage plans at the time of service.
Commercial carriers (Aetna, Anthem, Blue Cross Blue Shield, Cigna, and United Healthcare) who are ACA-compliant typically cover Preventive services (such as annual physical, nutrition visits, or lifestyle health counseling). Some medical services, such as a visit for a problem or chronic disease are subject to co-pay, co-insurance, or deductibles, including Chronic Care Management and Remote Patient Monitoring. There are three major ways that insurance is used to help cover the cost of your medical care: 1) co-pay, 2) co-insurance, or 3) high deductible. If your plan has a co-pay, we will collect it at the time of service. Usually, there will be nothing else owed for any services received. If your plan is a co-insurance plan, then we will not collect any amount at the time of service, but will send a statement with your co-insurance amount due (which is typically 20%). If you have a plan with an HSA (high deductible), then we will collect the full charge for services provided at the discount offered by your insurance carrier.
Fair market plans (often sponsored by a private company), Marketplace plans (ie., Caresource), and non-ACA commercial carriers (ie., Freedom Life) vary widely. Marketplace plans provide one wellness visit per year, but not lifestyle health and behavioral counseling (these plans follow Medicare B rules). We will do balance billing as legally permitted for services not covered by your insurance or deemed outside their policy coverage.
Other Terms: You can elect to receive a private benefits review for a cost, or we will provide a list of CPT codes that you can provide your insurance carrier to get benefits information. We will provide one copy of a lifestyle lab report at your request (specialized lab reports, not standard preventive or diagnostic) but there will be a charge for subsequent copies. Patients who receive lifestyle medicine services are automatically enrolled in a Chronic Care Management (CCM) plan. If you do not agree to receive CCM services, we will service your healthcare needs with direct patient encounters and may change your provider to a family medicine specialist.
We do charge for different types of encounters including monitoring, sitting fees, report fees, telephone calls, EHR photos and patient/physician communication, and for consultations required in complex situations.
If there is a credit due, we will apply to a future service unless you request a credit due sooner. Any credit balance due to a patient at the end of the year will be sent to the patient in the form of which it was received (ie., credit card).
Most services are eligible for coverage by an FSA or HSA card including certain services when ordered by a physician (ie., lifestyle monitoring if recommended by a physician, or special lab tests if ordered by a physician). We require that an FSA, HSA, or credit card be held on file for any plans that are not Medicare. We will send an invoice with the amount due via email. We will charge the card on file on the due date of the invoice (30 days from visit date or after EOB is processed) unless instructed by patient directly, in the case of financial hardship.
We accept non tax-deductible donations to help defray the cost for patients with financial hardships.
In an effort to provide transparency for our services, we provide a schedule of fees. If we are in network with an insurance carrier (have an agreed upon contract), we will only charge the amount we have agreed to with the insurance carrier. If we are out of network but your insurance uses a network where we have a contract, we will only charge the agreed upon contract rate with that network, unless it is for a charge they deny or deem medically unnecessary and you have received the services already at our location. Amounts shown for preventive and diagnostic labs are not included in the lifestyle monitoring plans, but are eligible for insurance coverage. Pricing is only valid for current patients who get a draw done in our facility. Patients must elect to self pay for a lab before the lab is drawn if they prefer to receive the special pricing. In many cases, if you have a third party or fair market plan, you will save money by using a self pay option. We can provide a likelihood of cost savings but we are not responsible for exact coverage. It is up to the patient to contact their insurance provider to get guaranteed benefits and coverage details. Prices on this list are subject to change.
Thank you for allowing Coze Health Medical LLC to be your healthcare provider. Our practice will work with you to help you fulfill your financial responsibility. We are dedicated to maintaining a high impact, quality healthcare experience with concierge-style treatment. In order to do this, it is important for you to present your insurance cards at the time of your visit. If you fail to provide a copy of your insurance cards, you will be considered self-pay and required to make a payment at the time of service. It is our aim to be as transparent about the services you receive and your financial obligation. Coze Health Medical LLC can provide a good faith estimate of services upon request (all prices are available on our website). Although we receive an eligibility and benefits report for each patient, we cannot guarantee benefits or coverage of the services we offer. It is the responsibility of the patient to verify their specific benefits eligibility prior to receiving services.
Medicare: Coze Health Medical LLC is a participating Medicare provider, accepting assignment for Medicare Part B (Physician Services) claims. The patient is financially responsible for their co-insurance, deductibles, and any services rendered that are not covered by Medicare.
Commercial/Marketplace Plans: Coze Health Medical LLC has established fees that are usual and customary for this healthcare service area. Every insurance carrier has their own usual and customary fee schedule; however, the patient is responsible for payment regardless of the insurance carrier's arbitrary determination of rates according to our contractual obligations. All co-pays are due at the time of service.
Non-covered Services: Some services we provide may be deemed not medically necessary by your insurance carrier or not covered benefit by your specific policy, therefore, not paid by your insurance. Many lifestyle counseling sessions and specialty labs are not covered by marketplace or non-Affordable Care Act insurance plans. The patient is responsible for payment at the time of service for all services not covered by insurance.
Laboratory Services: We offer in-house laboratory services for your convenience with a sitting fee but you may use any laboratory service. We provide a deep discount for many diagnostic labs with a fair market value comparison for your convenience but we cannot guarantee the fair market value. You may request for a self-pay rate at the time of services, or if you or your insurance requires the use of a specific lab for specimens, this needs to be clearly communicated to our staff prior to services being provided.
Self-pay and Financial Arrangements: Patients who do not have insurance coverage are considered to be self-pay. Self-pay patients payments are due at the time of service. We may consider payment arrangements for those patients who need assistance in meeting their account obligation. Coze Health Medical LLC reserves the right to set the terms and conditions for any payment arrangement.
Credit Cards: We accept all major credit cards, HSA, or FSA cards, and cover the transaction fees. If you do not have a card to put on file, please make arrangements with the office staff for payment options. If the patient has an approved payment arrangement, monthly credit card debits are offered as an option for payment.
Payment Terms: All patients are required to have an HSA, FSA, or credit card on file. We will expect payment for co-pays and services received by patients with high-deductible plans (HSA) or out-of-network benefits at the time of service. All additional charges after adjustments by insurance company will be charged to the card on file. Appointments not canceled within 48 hours (business days) will be charged a $75 cancellation fee (unless in the case of an emergency).